Hyposmia and cardiovascular dysautonomia correlatively appear in early-stage Parkinson's disease

Mizutani, Yasuaki; Nakamura, Tomohiko; Okada, Ayaka; Suzuki, Junichiro; Watanabe, Haruo; Hirayama, Masaaki; Sobue, Gen

doi:10.1016/j.parkreldis.2014.02.010

Cited by 29 publications

(20 citation statements)

References 28 publications

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“…One region with decreased CT in mild PD was the left olfactory cortex, which receives sensory information from the olfactory bulb (26), which is in keeping with the olfactory loss as one of the early non-motor manifestations of PD as well as with previous findings of Lewy pathology in anterior olfactory nucleus and olfactory bulb (27). We did not find the same alteration using VBM; however, CT analyses are more sensitive than VBM for identifying regional cortical thinning associated with PD because VBM merges information about morphology, size, and position and the final measures average information about thickness and cortical folding (2), possibly resulting in less sensitivity.…”

Section: Discussionsupporting

confidence: 66%

Pattern of Reduced Functional Connectivity and Structural Abnormalities in Parkinson’s Disease: An Exploratory Study

et al. 2017

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BackgroundMRI brain changes in Parkinson’s disease (PD) are controversial.ObjectivesWe aimed to describe structural and functional changes in PD.MethodsSixty-six patients with PD (57.94 ± 10.25 years) diagnosed according to the UK Brain Bank criteria were included. We performed a whole brain analysis using voxel-based morphometry (VBM–SPM 8 software), cortical thickness (CT) using CIVET, and resting-state fMRI using the Neuroimaging Analysis Kit software to compare patients and controls. For VBM and CT we classified subjects into three groups according to disease severity: mild PD [Hoehn and Yahr scale (HY) 1–1.5], moderate PD (HY 2–2.5), and severe PD (HY 3–5).ResultsWe observed gray matter atrophy in the insula and inferior frontal gyrus in the moderate PD and in the insula, frontal gyrus, putamen, cingulated, and paracingulate gyri in the severe groups. In the CT analysis, in mild PD, cortical thinning was restricted to the superior temporal gyrus, gyrus rectus, and olfactory cortex; in the moderate group, the postcentral gyrus, supplementary motor area, and inferior frontal gyrus were also affected; in the severe PD, areas such as the precentral and postentral gyrus, temporal pole, fusiform, and occipital gyrus had reduced cortical thinning. We observed altered connectivity at the default mode, visual, sensorimotor, and cerebellar networks.ConclusionSubjects with mild symptoms already have cortical involvement; however, further cerebral involvement seems to follow Braak’s proposed mechanism. Similar regions are affected both structurally and functionally. We believe the combination of different MRI techniques may be useful in evaluating progressive brain involvement and they may eventually be used as surrogate markers of disease progression.

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Section: Discussionsupporting

confidence: 66%

Pattern of Reduced Functional Connectivity and Structural Abnormalities in Parkinson’s Disease: An Exploratory Study

et al. 2017

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“…Previous studies have shown that age at onset, symptom severity and short symptom duration are negatively correlated with MIBG uptake . Other independent reports found that patients with PD with low MIBG uptake also have associated cognitive impairment, dementia, RBD, hyposmia, constipation and orthostatic hypotension . Recent research regarding the chronological change in MIBG uptakes in patients with PD revealed that there is heterogeneity in the MIBG uptake that may be associated with the evolution of Lewy body pathology in the myocardium .…”

Section: Discussionmentioning

confidence: 99%

Normal ‘heart’ in Parkinson's disease: is this a distinct clinical phenotype?

Kim

Park

et al. 2016

Euro J of Neurology

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“…In patients with PD, olfactory impairment has been correlated with cardiac sympathetic denervation [30, 31], even in the early stages of the disease [32]. Lee et al [33] reported that the degree of cardiac sympathetic dysfunction, as evaluated by cardiac MIBG scintigraphy, was positively correlated with the degree of olfactory identification impairment in patients with PD but not in patients with MSA.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson’s Disease and Atypical Parkinsonian Syndromes

et al. 2016

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BackgroundWe aimed to evaluate the utility of the combined use of cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, olfactory testing, and substantia nigra (SN) hyperechogenicity on transcranial sonography (TCS) in differentiating Parkinson’s disease (PD) from atypical parkinsonian syndromes (APSs), such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP).MethodsCardiac MIBG scintigraphy, card-type odor identification testing (Open Essence (OE), Wako, Japan), and TCS were performed with 101 patients with PD and 38 patients with APSs (MSA and PSP). Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of these batteries for diagnosing PD from APSs. The diagnostic accuracy of the three tests was also assessed among patients at the early disease stage (drug-naïve patients with a disease duration of 3 years or less).ResultsIn differentiating PD from APSs, the area under the ROC curve was 0.74 (95% CI, 0.65–0.83), 0.8 (95% CI, 0.73–0.87), and 0.75 (95% CI, 0.67–0.82) for TCS, cardiac MIBG scintigraphy, and olfactory testing, respectively. The diagnostic sensitivity and specificity were 53.1% and 91.7%, respectively, for TCS, 70.3% and 86.8%, respectively, for cardiac MIBG scintigraphy, 58.4% and 76.3%, respectively, for OE. Among early-stage patients, sensitivity and specificity were 50.0% and 93.8%, respectively, for TCS, 57.1% and 87.5%, respectively, for cardiac MIBG scintigraphy, and 54.8% and 79.2%, respectively, for OE. At least one positive result from 3 tests improved sensitivity (86.1%) but decreased specificity (63.2%). In contrast, at least 2 positive results from 3 tests had good discrimination for both early-stage patients (50.0% sensitivity and 93.8% specificity) and patients overall (57.8% sensitivity and 95.8% specificity). Positive results for all 3 tests yielded 100% specificity but low sensitivity (25%).ConclusionsAt least 2 positive results from among TCS, cardiac MIBG scintigraphy, and olfactory testing can support clinical diagnosis in distinguishing PD from APSs.

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Hyposmia and cardiovascular dysautonomia correlatively appear in early-stage Parkinson's disease

Cited by 29 publications

References 28 publications

Pattern of Reduced Functional Connectivity and Structural Abnormalities in Parkinson’s Disease: An Exploratory Study

Pattern of Reduced Functional Connectivity and Structural Abnormalities in Parkinson’s Disease: An Exploratory Study

Normal ‘heart’ in Parkinson's disease: is this a distinct clinical phenotype?

Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson’s Disease and Atypical Parkinsonian Syndromes

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